Complications Following Antireflux Surgery: Recognition and Management

Complications Following Antireflux Surgery: Recognition and Management George Ferzli, MD, FACS

Anti-reflux surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Rudolph Nissen, MD INFLUENTIAL PEOPLE: Lortat-Jacob, MD AndreToupet, MD Jacques Dor, MD Ernst Heller, MD Rudolph Nissen MD Ivor Lewis, MD J. Leigh Collis, MD K. Alvin Merendino, MD Lucius Hill, MD Ronald Belsey, MD Alan Thal, MD

Intra-operative complications Pleura / lung breech during hiatal dissection

Intra-operative complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Post-operative complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fistulas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fistulas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Failed anti-reflux surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Failed antireflux symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pre-operative work-up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],GE junction Confluence of diaphragm Top of mediastinal gastric tissue Not exceed 5cm for laparoscopy Not exceed 2cm for laparoscopy

Pre-operative work-up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pre-operative work-up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Predictability of mechanism of failure Iqbal et al. 104 failed anti-reflux procedures Iqbal et al. Reoperation for Failed Anti-Reflux Surgery. Ann Surg 2006; 244: 42-51. Mechanism of failure % of pre-operative predictability Crus closure failure 96 Hiatal stenosis 20 Partial fundoplication disruption 86 Complete fundoplication disruption 86 Hypertensive fundoplication 92 Slipped fundoplication 89 Loose fundoplication 50 Short esophagus 37 Gastroparesis 100

Additional causes of failure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Operative approach ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Iqbal et al. Reoperation for failed anti-reflux surgery. Ann Surg 2006;244: 42-51. Not exceed 2cm for laparoscopy

Re-operative management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Tuomo et al. Complications in Antireflux Surgery: National-Based Analysis of Laparoscopic and Open Fundoplications. Arch Surg 2008;143: 359-365.

Re-operative management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Granderath et al. Laparoscopic Revisional Fundoplication with Circular Hiatal Mesh Prosthesis: The Long-Term Results. World J Surg 2008; 32: 999-1007.

Polypropylene mesh Esophagus ,[object Object],[object Object],[object Object],[object Object],Mesh Wrap Circular mesh Fundoplication

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Re-operative management Collis 4cm

Re-operative management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Khajanchee et al. Laparoscopic Reintervention for Failed Antireflux Surgery. Arch Surg 2007;142(8): 785-792

Pitfalls ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Complications and results after re-operation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Anti-reflux Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object]

Anti-reflux Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Indications for Re-operation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Furnée EJB et al. Surgical Reintervention After Failed Antireflux Surgery: A Systematic Review of the Literature. J Gastrointest Surg 2009. Published online ahead of print

Re-operative management ,[object Object],[object Object],[object Object],[object Object],[object Object],Tuomo et al. Complications in Antireflux Surgery: National-Based Analysis of Laparoscopic and Open Fundoplications. Arch Surg 2008;143: 359-365.

Complications Following Antireflux Surgery: Recognition and Management

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Complications Following Antireflux Surgery: Recognition and Management